Provider Demographics
NPI:1497764302
Name:SAUCEDA, ANA TREVINO (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:TREVINO
Last Name:SAUCEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:T
Other - Last Name:SAUCEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PLLC
Mailing Address - Street 1:2829 BABCOCK RD
Mailing Address - Street 2:SUITE 636
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6014
Mailing Address - Country:US
Mailing Address - Phone:210-615-8460
Mailing Address - Fax:210-615-0406
Practice Address - Street 1:2829 BABCOCK RD
Practice Address - Street 2:SUITE 636
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6014
Practice Address - Country:US
Practice Address - Phone:210-615-8460
Practice Address - Fax:210-615-0406
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2077207N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177483804Medicaid
TX8F22850Medicare PIN
TXTXB126204Medicare PIN